HomeMy WebLinkAboutBUILDING PERMIT APPLICATIONAll APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED
Date• % /q A2 Permit Number:
ik3t b'' y
BuildingPermit Application
now"__ 1111111111111F
Planning and Development Services
Building and Code Regulation Division
1300 Virginia Avenue, Fort Pierce FL 34982
Phone: (772) 462-1553 Fax: (772) 462-1578 Commercial Residentialxa
PERMIT TYPE:
PROPOSED IMPROVEMENT LOCATION:
Address: 3 5' S N ---f}b- ✓
Property Tax ID #: 41 -O X - SO / Lot No.
Block No.
Site Plan Name:
Proiect Name:
DETAILED DESCRIPTION OF WORK:
CONSTRUCTION INFORMATION: I
Additional work to be performed under this permit -check all that apply:
_Mechanical
&-&ctric
_ Gas Tank
_ Plumbing
Total Sq. Ft of Construction:
_ Gas Piping
_ Sprinklers
_ Shutters
Generator
Sq. Ft. of First Floor:
Windows/Doors
Roof Pitch
Cost of Construction: $ 1 %G 0 1
w Utilities: _ Sewer _ Septic Building Height:
OWNERAESSEE:
CONTRACTOR:
Name 16!+& 1 ar�
Name:John Law
Address `� �l C u ter .r �" r %
Company:Law's Electrical Service Inc.
Address:5158 NW Primm St
City: 10/ fState: &Jef
Zip Code: OR 3 Co U Fax:
Phone No. l ^ S"D S- 7 °'i 7 - 0 2 S y
City: Pt St Lucie State: FI
Zip Code: 34983 Fax:
Phone No 772 370 4357
E-Mail:
Fill in fee simple Title Holder on next page (if different
from the Owner listed above)
E-Maii)ohnlaw5158gaol-com
State or County License EC 13006370 29432
If value of construction Is $2500 or more, a RECORDED Notice or Commencemen. i• 1=v—=
if value of HVAC is $7,500 or more, a RECORDED Notice of Commencement Is required.
SUPPLEMENTAL CONSTRUCTION LIEN LAW IN
Name: - —
Address:
City: State:
Zip: Phone
FEE SIMPLE TITLE HOLDER: _ Not Applicable
Name:
Address:
City:
Zip: Phone:
MORTGAGE COMPANY: _ Not Applicable
Name:
Address: State:
City:
Zip: Phone:
BONDING COMPANY: _Not
Name:
Address:
City:
zip: Phone,
OWNER/ CDNTRACTOR AFFIDVIT: Application is hereby made to obtain a permit to do the work and instaiiation as indicated.
I certify that no work or instatlation has commenced prior to the Issuance of a permit.
ct
St. L cie C
whim is Ir
mit holder to build the subject sihru ure
any restrictions which may apply. ibit such
structure.
In consideration of the granting of this requested permit, I do hereby agree that I will, in all respects, perform the work
in accordance with the approved plans, the Florida Building Codes and St. Lucie County Amendments.
The following building permit applications are exempt from undergoing a full concurrency review: room additions,
accessory structures, swimming pools, fences, walls, signs, screen rooms and accessory uses to another non-residential ng � for
WARNING TO OWNER: your failure to Record a Notice of Commencement may result in your pay
Improvements to your property. A Notice of Commencement must be recorded and posted on the jobsite
before the first inspection. If you intend to obtain financing, consult with lender or an attorney before
Agent
STATE OF FLORIDA
COUNTY OF
The forgoing instrument was acknowledged before me
this itt day of _2141-n , 20-2.by
Name of person marking statement
Personally Known OR Produced Identification
Type of identification
Produced
Public- State
FtACHEL
•,.-.,,-.� i. al)l MY Comm
Commission No. :,... -
•�' SIW EXPIRES
REVIEWS FRONT 1 COUNTER I REVIIEW REVIEW SUPERVISOR
Rev. 8/2/17
STATE OF FLORIDA
COUNTY OF
The foing instrument was acknowledged me
rrggo�
this // day of - 4
Name of person rKIng statement
Personally Known OR produced identification
Type of Identification
Produced
Notary Pubec- State of
DAVIS 6
"" RACHEL M
p,:
5, 20tB �.E'f MY COMMISSION
PLANS I VEGETATION
REVIEW REVIEW